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Glossary

Skin incision

Either a posterior skin incision with a lateral skin flap or a lateral skin incision can be used.

For a lateral skin incision, place the elbow at 90 degrees and try to pinch the lateral condyle (easier in thin patients). Make a straight skin incision directly over the middle of the lateral condyle. Start with a small incision (6-8 cm or so) and extend proximal or distal as needed.

Note: The posterior interosseous nerve, within the supinator muscle, crosses the posterior radius, from anteriorly, three finger-breadths distal to the radial head. It must be protected during this approach.

Superficial surgical dissection

Kaplan interval

It can be difficult to determine exact muscle intervals. When we are operating on the radial head, there is usually associated injury to the lateral collateral ligament and common digit and wrist muscle origins. Along with this damage there is usually a rent in the fascia that can be opened and extended distally. This usually lies in the interval between the extensor carpi radialis brevis and extensor digitorum communis (Kaplan interval). The associated ligament and muscle injury will make the rest of the exposure very easy.

The Kaplan interval can also be identified by elevating the origin of the extensor carpi radialis brevis from the supracondylar ridge of the distal humerus, elevating the brachialis from the anterior humerus, then continuing distally until the joint is entered and the capitellum is visualized. Elevating these muscles is necessary to exposure the coronoid from the lateral side. Split the common wrist and digital extensor musculature at the point that divides the capitellum in half anterior/posterior.

Deep surgical dissection

Osteotomy of lateral epicondyle

If the lateral collateral ligament is intact and better exposure of the radial head and neck are desired, one can consider osteotomy of the lateral humeral epicondyle. The osteotomy line in the illustration is marked in red.